A Study of the Experience of Sexually Assaulted Pregnant Minors Who Seek Access to Abortion-Related Services Through the Kamuzu Central Hospital One- Stop Centre
Kamuzu University of Health Sciences
Type of Study: An exploratory cross-sectional qualitative study aimed at examining the experiences of pregnant minors who seek abortion-related care through the Kamuzu Central Hospital (KCH) One Stop Centre (OSC). Background: Girls and young women who have survived rape, defilement, and sexual assault are at high risk of pregnancy. Research has shown that younger unmarried and economically dependent women and girls who receive maternity care in various health facilities report having become pregnant through rape and defilement. For girls aged between 12 and 19 years in Malawi, the risks associated with pregnancy and abortion are high. Abortion is only legal in Malawi when the pregnant woman’s life is in danger and obtaining an abortion, aside from this one condition is punishable by 7-14 years’ imprisonment. Nevertheless, it does not stop abortion from occurring. In an assault report presented by the KCH OSC for the period January-November 2021, cases of defilement, rape, physical assault, emotional assault, and followed by sodomy, abduction, and early child marriages were reported, and there were cases of girls between the ages of 11 and 19 whose sexual violation resulted in pregnancy. In terms of managing pregnancies, the staff at the OSC counsel clients, and provide ante-natal care and delivery services. However, clients who request termination are informed this service is not available because it is illegal. It was also reported that there is a high demand for termination of pregnancy services from girls and women whose pregnancies resulted from sexual violation. Objectives: The overall goal of this research is to explore the experiences of pregnant minors (aged 10-17 years) who seek abortion-related care. The specific objectives are to: 1. Assess the lived experiences of pregnant minors who have been refused access to safe abortion. 2. Evaluate the impact of national laws on the health and well-being of the pregnant minors denied access to safe abortion at the OSC 3. Examine policy/program level and community level stakeholders’ perceptions on the relationship between hospital policies and practices on the provision of safe abortion to minors and the legal framework. Study design, population, sample size and sampling strategy: The study will use an exploratory cross-sectional qualitative design to examine the experiences of pregnant minors who seek abortion-related care. The proposed study will be conducted amongst pregnant and previously minors (10-17 years) following sexual assault; parents/guardians of pregnant minors (10-17 years) recruited in the study; health service providers at the One Stop centre; and key stakeholders. Thirty participants will take part in the study. Pregnant minors will be sampled using a combination of purposive and snowballing methods while the rest of the population will be sampled purposively to ensure rich data is collected. Study Site, Study period and data collection: The study will be conducted in Lilongwe district through the Kamuzu Central Hospital One Stop Centre. It is expected that this study will run fromDecember 2022 to March 2023. In-depth interviews, key informant interviews and semistructured interviews will be used to collect data Data management and analyses: Data collection and analysis will partly be done concurrently and audio-recorded interviews will be translated and transcribed verbatim by trained transcribers. Before analysis, transcripts will be anonymised. Data will be analyzed using qualitative thematic analysis methods. The analysis will use a hybrid of the deductive and inductive approach Dissemination Plans: Initially, the study findings will be shared with Options Consultancy Services Ltd. Subsequently, the study findings will be shared with the participating institutions such as the KCH OSC, MOH-RHD and other key stakeholders. The study findings will also be disseminated to wider audiences such as national, regional and global audiences. The study reports will also be shared with the College of Medicine Research and Ethics Committee (COMREC, as required. The results will also be presented at relevant regional and international conferences and published in relevant peer-reviewed journals. Anticipated challenges: Some of the actors such as service providers may feel uncomfortable when asked questions about the provision of abortion services. The researcher also realizes the sensitivity of the matter such that the minors may not be able to share their experiences. To minimize this, we will inform the participants that participation in this study is voluntary and they can stop participation at any time. Study staff will make every attempt to ensure a comfortable and secure environment in which to interact with participants, and will be trained to protect confidentiality. Potential use of results: The findings of the research will contribute to understanding the impact of laws and policies on the lives of minors who are pregnant due to sexual assault. It will also contribute to clarifying the relationship between hospital practices in the provision of safe abortion to minors and the legal framework. The Research will generate new evidence on barriers to safe abortion services access. This will reignite new discussions, raising the profile and visibility of the importance of legislative and policy reforms to address unsafe abortion.